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PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS�� �r-r / SUITE/Apia
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PLAT NAME/SUBDIVISION NO. LOT NO LID NO
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NEW RESIDENTIAL UMBING / ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UP SIDE REAR
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❑COMMERCIAL NCE OR
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1:1 MIXED USE PARKING LOTAREA jPLANINUPENVI DBY DATE1:1REMODEL ❑ MULTIFAMILY SIGN REQ'D PROVIDED 'QURSU TTO cT
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPONIN: OCCUPANT
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OF DWELLINGSPECIAL INSPECTION CONSULTANT OCCUPANT
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DESCRIBE WORK TO BE DONE REQUIRED CI YES
( REMARKS PURSUANT TO UPC 605.2 =
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ITorcGEOTECH REPORT m
BY: SHA�.L BE INSTALLED oN THF,
STRUCTURAL DEWEASIT ENTERS TFIE BUILDING
BY:
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO:Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO MBChanIC81
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
J SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE• ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp, Total Amt. Due
x NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Budding Official or his/her Deputy' and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THEDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WO KMEN'S COMPEN T U NCE AND RCW 18:27. OFFICIAL SIGNATURE DATE
SIG A (OWNER R NT): DATE SIGNED (425, ��7
~ 771-0220 RELEASED BY DA E
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 l IBC110 1 IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
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